Browsing by Author "Toso Milos, Alberto Antonio"

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    Antenatal Exposure to Magnesium Sulphate and Neonatal Outcomes in Very Low Birth Weight Infants: a multicenter study.
    (2023) Ferreira, María Vaz; Caro, José; Villarroel, Luis; Muñoz, Sergio; Álvarez, Patricia; Flores, Gerardo; Herrera, Tamara; Toso Milos, Alberto Antonio; Toso Milos Paulina Alejandra; Tapia, José
    Objective: To explore the association between antenatal magnesium sulphate ( MgSO4 ), mortality and incidence of intraventricular hemorrhage (IVH) in very low birth weight (VLBW) infants. Study design: Retrospective, cohort study of infants < 32 weeks’ GA born at centers of NEOCOSUR Network between January 2015 and December 2020. Subjects were categorized as exposed vs non-exposed to antenatal MgSO4. Primary outcomes were death, incidence of severe IVH (Grade III-IV) and severe IVH/death. Secondary outcomes included relevant morbidities. Results: 7418 VLBW infants were eligible. Antenatal MgSO4 was associated with a signicantly decreased death rate after admission (aOR 0.59 [95% CI, 0.46–0.74]) and severe IVH/ death (aOR 0.63 [95% CI, 0.490.83]). No signicant reduction in severe IVH was observed (aOR 0.89 [95% CI, 0.63–1.25]). No differences between groups were observed in rates of morbidities. Conclusion: Antenatal MgSO4 was associated with a decreased death rate after admission and in severe IVH/ death.
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    Differential effects of propofol anaesthesia across three amplitude-defined electroencephalographic states in sedated critically ill term neonates
    (European Society of Anaesthesiology and Intensive Care, 2025) Boncompte Lezaeta, Gonzalo Nicolas; Cortinez Fernández, Luis Ignacio; Toso Milos, Alberto Antonio; Giordano Villatoro, Ady Iveth; Cruzat Riquelme, Francisco Javier; Fuentes, Ricardo; Pedemonte Trewhela, Juan Cristóbal; Contreras Ibacache, Víctor Eliseo; Biggs Muñoz, Daniela Paola; Chiu, Esteban; Ibacache Figueroa, Mauricio Enrique
    The developing neonatal brain displays different electroencephalographic (EEG) responses to GABAergic anaesthetics than adults. Evidence suggests the importance of isoelectric-like activity patterns. However, markers of hypnotic depth are currently lacking for this population. OBJECTIVE To explore potential EEG markers of propofol-induced hypnosis in sedated critically ill term neonates. DESIGN Observational exploratory cohort study. PATIENTS Twenty critically ill term neonates (postmenstrual age 37 to 44 weeks) undergoing intensive care and requiring anaesthesia for noncardiac surgery. Patients with perinatal asphyxia, neurological pathology, brain malformations and metabolic or haemodynamic instability were excluded. INTERVENTION(S) Frontal EEG (Sedline) was recorded before induction and during a 20-min continuous rate propofol infusion. MAIN OUTCOME MEASURES Depending on peak amplitude, segmented EEG signals (1 s epochs) were classified as either isoelectric (<10 μV), low-voltage 10 to 25 μV), or high-voltage (>25 μV). Propofol effects were evaluated in terms of time occupancy and spectral properties within these EEG states. Correlations between clinical variables and EEG states were explored. RESULTS The EEGs of 17 neonates were analysed. Most showed periods of low-voltage (16/17, 94%) and isoelectric states (2/17, 70.5%) before anaesthesia. The time spent in these EEG states increased significantly during propofol infusion; 17/17 (100%), P < 0.001 and 16/17 (94.1%), P = 0.016, respectively. Propofol increased the mean [95% confidence interval (CI)] time spent in the isoelectric state per patient: 12.4 (3.3 to 21.5)% versus 28.6 (14.4 to 42.8)%, P < 0.002. A reduced spectral power was observed across all frequency bands during low-voltage states (all P < 0.026). Gestational age was negatively correlated with time in the isoelectric state; rho, 95% CI, −0.539 (−0.11 to −0.87), P = 0.031. CONCLUSION Our results show that isoelectric periods are common before anaesthesia in our studied population and more frequent in patients born at earlier gestational ages. The data suggest that propofol anaesthesia increases isoelectric EEG states while also reducing the spectral power, specifically during low-voltage EEG states. Potentially, both of these EEG changes could be biomarkers of neonatal hypnosis depth in this particular critically ill subpopulation. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT04904965.
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    Doble arco aórtico y fistula aortotraqueal como causa de hemorragia masiva fatal: una asociación rara y peligrosa
    (2024) Ramos, Phoebe H.; Cabello, Pablo; Contreras, Alondra; Albrich, Diego; Toso Milos, Alberto Antonio
    Vascular rings are unusual congenital malformations. Among them, double aortic arch (DAA) is often difficult to diagnose due to its low incidence of symptoms. DAA can be associated with tracheal or esophageal compression and, in severe cases, could require tracheal intubation or chronic use of a nasogastric tube. This scenario favors the development of aortotracheal fistulas (ATF) or aortoesophageal fistulas (AEF).
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    Population pharmacokinetics of amikacin in suspected cases of neonatal sepsis
    (Wiley, 2023) Severino Cuevas, Nicolás Felipe; Urzúa Baquedano, Maria Soledad; Ibacache Figueroa, Mauricio Enrique; Paulos Arenas, Claudio; Cortinez Fernandez, Luis Ignacio; Toso Milos, Alberto Antonio; Leguizamon Marino, Liliana Marcela; Inojosa Mackenzie, Fernanda; Maccioni Romero, Andrea Ana; Meza Cañas, Sebastián Jaime; Garcia, Andres; Ramirez, Marcelo; Von Mentlen Gutierrez, Catalina Paz; Ceballos Jorquera Javiera Nicol; Paredes Galvez, Noemi Saray
    Aims:This study aimed to characterize the population pharmacokinetic parameters of intravenously administered amikacin in newborns and assess the effect of sepsis in amikacin exposure. Methods: Newborns aged >= 3 days who received at least 1 dose of amikacin during their hospitalization period were eligible for the study. Amikacin was administered intravenously during a 60-min infusion period. Three venous blood samples were taken from each patient during the first 48 h. Population pharmacokinetic parameter estimates were obtained using a population approach with the programme NONMEM. ResultsData from 329 drug assay samples were obtained from 116 newborn patients (postmenstrual age [PMA] 38.3, range 32-42.4 weeks; weight 2.8, range 1.6-3.8 kg). Measured amikacin concentrations ranged from 0.8 to 56.4 mg/L. A 2-compartment model with linear elimination produced a good fit of the data. Estimated parameters for a typical subject (2.8 kg, 38.3 weeks) were clearance (Cl = 0.16 L/h), intercompartmental clearance (Q = 0.15 L/h), volume of distribution of the central compartment (Vc = 0.98 L) and peripheral volume of distribution (Vp = 1.23 L). Total bodyweight, PMA and the presence of sepsis positively influenced Cl. Plasma creatinine concentration and circulatory instability (shock) negatively influenced Cl. ConclusionOur main results confirm previous findings showing that weight, PMA and renal function are relevant factors influencing newborn amikacin pharmacokinetics. In addition, current results showed that pathophysiological states of critically ill neonates, such as sepsis and shock, were associated with opposite effects in amikacin clearance and should be considered in dose adjustments.
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    Propofol induce modulaciones espectrales diferenciales en los estados isoeléctricos en el EEG de neonatos
    (2023) Ibacache Figueroa, Mauricio Enrique; Boncompte Lezaeta, Gonzalo Nicolás; Cortinez Fernández, Luis Ignacio; Toso Milos, Alberto Antonio; Fuentes, Ricardo; Contreras Ibacache, Victor Eliseo; Biggs Muñoz, Daniela Paola; Chiu, Esteban
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    Transmisión de la enfermedad de Chagas por vía oral
    (2011) Toso Milos, Alberto Antonio; Vial U., Felipe; Galanti Garrone, Norbel Luis
    The traditional transmission pathways of Chagas' disease are vectorial, transfusional, transplacental and organ transplantation. However, oral transmission is gaining importance. The first evidence of oral transmission was reported in Brazil in 1965. Nowadays the oral route is the transmission mode in 50% of cases in the Amazon river zone. Oral infection is produced by the ingestion of infected triatomine bugs or their feces, undercooked meat from infested host animals and food contaminated with urine or anal secretion of infected marsupials. Therefore travelers to those zones should be advised about care to be taken with ingested food. In Chile, this new mode of transmission should be considered in public health policies.